Wolters Kluwer Health
may email you for journal alerts and information, but is committed
to maintaining your privacy and will not share your personal information without
your express consent. For more information, please refer to our Privacy Policy.

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

A 22-year-old woman presented with intermittent left lower quadrant abdominal pain for 6 months. She was diagnosed as having had tuberous sclerosis (TS) during childhood based upon characteristic skin findings and recurrent seizures.

An abdominal computed tomography scan and esophagogastroduodenoscopy were unremarkable. Colonoscopy revealed 2 diminutive rectal polyps. Pathology revealed smooth muscle proliferation consistent with hamartomatous polyps. Capsule endoscopy revealed a large pedunculated multilobular polyp in the mid-jejunum (Fig. 1). A single-balloon enteroscopy identified a 3-cm pedunculated polyp (Figs. 2 and 3) in the jejunum, which was removed with a hot snare. Pathology revealed smooth muscle and vascular proliferation. Stains for angiomyolipoma (HMB-45) were negative and the polyp was determined to be a hamartoma (Fig. 4). The patient has remained asymptomatic postpolypectomy.

The most common gastrointestinal manifestation of TS is hamartomatous polyps of the rectosigmoid (1,2). In 1 report, 11 of 15 patients had hamartomatous rectal polyps (3). In another report, 5 of 12 patients had hamartomas (4). Although symptomatic angiomyolipomas of the small intestine have been reported in TS, there are no case reports documenting symptomatic small-bowel involvement by nonangiomyolipoma hamartomas (5–8). This is the first report of a symptomatic, partially obstructing, nonangiomyolipoma hamartoma of the small intestine from TS.